Traci Walk
Individual provider Active NPI Physical Therapy Assistant · Dieterich, IL
NPI 1346694841 · NPPES record last updated Apr 20, 2016
Key facts
- NPI
- 1346694841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160006981 (IL)
- Practice address
- 20379 E 1100TH Ave
Dieterich, IL 62424-2114 - Phone
- (217) 663-2876
- NPI assigned
- Apr 20, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160006981 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160006981 | IL | Yes |
Addresses
Primary practice location
20379 E 1100TH Ave
Dieterich, IL 62424-2114
Mailing address
20379 E 1100TH Ave
Dieterich, IL 62424-2114
Other providers in Dieterich, IL
- Mid-Illinois Medical Care Associates, LLC
- Morgan Michelle Repking
- Michelle Schnepper
- Stephanie Shadle
- Jennifer J Tinsley
- Diana Williams
All providers in Dieterich, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.